Post Tuberculous Kyphosis - Abstract
Introduction: Tuberculosis of the spine and its sequelae constitute a major burden
on healthcare systems in the developing world and requires meticulous attention to
detail, the appropriate surgical skill and good perioperative support systems to optimize surgical outcomes
Objectives: To highlight the peculiar challenges associated with managing complex
spine deformities arising from post TB infection in the developing world.
Methodology: A comprehensive review of three pediatric patients with severe post TB kyphosis treated with Posterior vertebral column resection (VCR), fusion and
instrumentation. Posterior VCR involves complete resection of a vertebra undertaken from a posterior approach. In the thoracic spine it involves a costo transversectomy, careful dissection of lateral and anterior margins of vertebral body, resection of body of vertebra while providing support for the spinal cord with rods placed across it in pedicle screws. This is followed by laminectomy. The opposing cartilaginous endplates of the vertebral bodies above and below resected vertebra is excised. A structural graft is then placed anterior to the spinal cord. A description of the presentation and treatment protocol was outlined.
Results: The kyphotic deformities were first subjected to Halo gravity traction in an
attempt to decrease the deformity while improving the nutritional status in one severely malnourished patient. A post-operative infection occurred in one patient requiring revision surgery. A second patient had persistent psoas abscess which required a second operation with anterior drainage, debridement and fusion. All three patients have had excellent recovery with fusion two years post op.
Conclusion: Post TB kyphosis is a common sequela of Tuberculosis of the spine
which can lead to paralysis. Surgical intervention requires a complex resection and
fusion which can be successfully achieved in the properly selected patient.